The first baby born live following a uterus transplantation from a deceased donor in Brazil offers hope for women with uterine infertility…

The 32-year-old recipient was born without a uterus as a result of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.

She had an in-vitro fertilisation (IVF) cycle four months before the transplant, resulting in eight fertilised eggs which were cryopreserved.

The 45-year-old donor died of subarachnoid haemorrhage (a type of stroke involving bleeding on the surface of the brain).

Over 10 hours in surgery

The 10,5-hour surgery took place in September 2016 and involved connecting the donor uteri and recipient’s veins and arteries, ligaments, and vaginal canals

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After surgery, the recipient received five immunosuppression drugs, as well as antimicrobials, anti-blood clotting treatment and aspirin. Immunosuppression was continued outside hospital until the birth.

Five months after transplantation, the uterus showed no signs of rejection, ultrasound scans showed no anomalies, and the recipient was having regular menstruation.

Pregnant 10 days after implantation

The fertilised eggs were implanted after seven months and, 10 days after implantation, the recipient was confirmed to be pregnant.

There were no issues during the recipient’s pregnancy, other than a kidney infection at 32 weeks which was treated with antibiotics.

How to cope with infertility

Hello baby girl

The baby girl was born via Caesarean section at 35 weeks and three days and weighed 2,550g.

The transplanted uterus was removed during the Caesarean section and showed no anomalies.

Both the recipient and baby were discharged three days after birth, with an uneventful early follow-up. The immunosuppressive therapy was suspended at the end of the hysterectomy.

Previously, there have been 10 other uterus transplants from deceased donors attempted in the USA, Czech Republic and Turkey, but this is the first to result in a live birth.

What causes uterine infertility?

Infertility affects 10-15% of couples of reproductive age. Of this group, one in 500 women have uterine anomalies due to congenital anomalies, or through unexpected malformation, hysterectomy, or infection.

Before the advent of uterus transplants, the only available options to have a child were adoption or surrogacy.

Improving uterus donation

Currently, uterus donation is only available when family members are willing to donate. With live donors in short supply, uterus transplants from deceased donors may help give more women the option of pregnancy.

“The use of deceased donors could greatly broaden access to this treatment, and our results provide proof-of-concept for a new option for women with uterine infertility,” says Dr Dani Ejzenberg, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, who led the research.

“The first uterus transplants from live donors were a medical milestone, creating the possibility of childbirth for many infertile women with access to suitable donors and the needed medical facilities. However, the need for a live donor is a major limitation as donors are rare, typically being willing and eligible family members or close friends. The numbers of people willing and committed to donate organs upon their own deaths are far larger than those of live donors, offering a much wider potential donor population.”

Transplants from deceased donors might also have some benefits over donations from live donors, including removing surgical risks for a live donor.

Source: The Lancet via www.sciencedaily.com

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